Nikki quoted this article from Birth:


> Results: We enrolled 189 women, contacted=
> =20
> 177 women postpartum, and obtained complete data on 171 women. Of these,
> 59=20
> percent received epidural analgesia, 72 percent breastfed fully, and 20=20
> percent breastfed partially (> 50% of infant nutrition) at 6 weeks=20
> postpartum. After controlling for demographics and labor outcome, we
> could=20
> not demonstrate a correlation between breastfeeding success at 6 to 8
> weeks=20
> and labor analgesia. Conclusions: In a hospital that strongly promotes=20
> breastfeeding, epidural labor analgesia with local anesthetics and
> opioids=20
>

A couple of thoughts about this article which I've been mulling over:

I think they measured the wrong thing.  I would like to see the length of
time it takes to establish *effective* breastfeeding after an epidural --
measuring the length of time the epidural is in place, the number of boluses
the woman gets, and the type of opoid that is used for the analgesia.  If you
have enough lactation consultants to work patiently with these moms and
babies and get them over the hump of the baby not latching on, I see no
reason for these women to not go on and have *good* breastfeeding success at
6 to 8 weeks, which is what they measured.  But I'd like to know what it took
to get them out of the hospital breastfeeding successfully.  Another study,
similar to the ones done by Matthews (1989) and Crowell (1994) that looked at
the length of time it took to establish effective feeds after using CNS
depressant drugs in labor (Nisentil in one case, I believe it was Stadol in
the other) would be helpful.  Jan Riordan's study did look at this (2000) and
did use the same scoring method (IBFAT) but didn't look at the length of time
the epidural was in place or numbers of boluses, etc.

I would venture a number of the mothers I work with who have been persistent
and not given up who have had epidurals would claim wonderful bf success at 6
to 8 weeks -- and I'd join in applauding them.  But what it took to get
there????  That's the $64 question.

Jan Barger, RN, MA, IBCLC
Administrative & Program Director
Lactation Education Consultants
Wheaton, Illinois

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